目的：分析难治性青光眼患者睫状体光凝术后干眼的影响因素，并构建风险预测模型。

方法：回顾性分析2021年1月至2024年1月本院收治的难治性青光眼患者303例308眼的临床资料，实行睫状体光凝术治疗，统计术后3 mo的干眼发生率； 根据术后干眼发生情况分为发生组(n=105)、未发生组(n=198)，收集2组病历资料，对其干眼发生的影响因素进行Logistic回归分析； 基于Logistic回归分析结果使用R3.4.3软件制作Nomogram模型； 绘制受试者工作特征曲线(ROC)评估Nomogram模型的风险预测能力，绘制校准曲线检测Nomogram模型的校准度。

结果：难治性青光眼患者睫状体光凝术后干眼发生率为34.65%； 年龄(OR=1.343，95%CI：1.102-1.637)、糖尿病(OR=1.219，95%CI：1.044-1.423)、干燥综合征(OR=1.289，95%CI：1.070-1.553)、角结膜疾病(OR=1.366，95%CI：1.116-1.672)、睑脂黏度3-4级(OR=1.168，95%CI：1.040-1.311)、结膜松弛3-4级(OR=1.158，95%CI：1.028-1.305)、术中术眼镜下暴露时间(OR=1.415，95%CI：1.129-1.773)、术后日均电子产品使用时间(OR=1.366，95%CI：1.108-1.685)、术后辅助使用激素眼液(OR=1.231，95%CI：1.026-1.477)为难治性青光眼患者睫状体光凝术后干眼的影响因素(均P<0.05)； ROC曲线显示Nomogram模型预测术后干眼发生的曲线下面积、灵敏度、特异度分别为0.930(95%CI：0.895-0.956)、96.19%、82.83%，Nomogram模型内部验证显示C-index值为0.859，Hosmer-Lemeshow拟合优度检验(χ²=1.972，P=0.396)显示拟合良好。

结论：年龄、糖尿病、干燥综合征、角结膜疾病、睑脂黏度3-4级、结膜松弛3-4级、术中术眼镜下暴露时间、术后日均电子产品使用时间、术后辅助使用激素眼液为难治性青光眼患者睫状体光凝术后干眼的影响因素，综合上述因素构建的风险预测模型对术后干眼发生风险有预测作用。

METHODS:From January 2021 to January 2024, the clinical data of 303 patients(308 eyes)with refractory glaucoma in our hospital were analyzed retrospectively, and the incidence of dry eye was counted 3 mo after operation. They were divided into two groups according to the incidence of dry eye after operation: an occurrence group(n=105)and a non-occurrence group(n=198). The medical records of the two groups were collected, and the influencing factors of dry eye were analyzed by Logistic regression. The Nomogram model was made by R3.4.3 software based on the results of Logistic regression analysis. The risk prediction ability of Nomogram model was evaluated by receiver operating characteristic(ROC)curve, and the calibration degree of Nomogram model was detected by calibration curve.

RESULTS:The incidence of dry eye in refractory glaucoma patients after ciliary photocoagulation was 34.65%. Age(OR=1.343, 95% CI: 1.102-1.637), diabetes(OR=1.219, 95% CI: 1.044-1.423), Sjogren's syndrome(OR=1.289, 95% CI: 1.070-1.553), keratoconjunctival diseases(OR=1.366, 95% CI: 1.116-1.672), eyelid fat viscosity 3-4 grade(OR=1.168, 95% CI: 1.040-1.311), conjunctival relaxation 3-4 grade(OR=1.158, 95% CI: 1.028-1.305), exposure time under glasses during operation(OR=1.415, 95% CI: 1.129-1.773), the average daily use time of electronic products after operation(OR=1.366, 95% CI: 1.108-1.685)and the auxiliary use of hormone eye drops after operation(OR=1.231, 95% CI: 1.026-1.477)were the influencing factors of dry eye after ciliary body photocoagulation in refractory glaucoma patients(all P<0.05). ROC curve showed that the area under the curve, sensitivity and specificity of Nomogram model in predicting postoperative dry eye syndrome were 0.930(95% CI: 0.895-0.956), 96.19% and 82.83%, respectively. The internal verification of Nomogram model showed that the C-index value was 0.859, Hosmer-Lemeshow goodness-of-fit test(χ²=1.972, P=0.396)showed a good fit.

CONCLUSION: Age, diabetes, Sjogren's syndrome, keratoconjunctival disease, eyelid fat viscosity 3-4 grade, conjunctival relaxation 3-4 grade, exposure time under glasses during operation, average daily use time of electronic products after operation, and adjuvant use of hormone eye drops after operation are the influencing factors of dry eye in refractory glaucoma patients after ciliary body photocoagulation, the risk prediction model based on the above factors can predict the risk of dry eye after operation.